Avaliação da eficácia da terapia complementar não-farmacológica na administração de auto-plasma rico em plaquetas na reparação tecidual de úlceras crônicas de membros inferiores

Abstract

The ulcers of the lower limbs may be related to various etiologies, among them diabetes, venous insufficiency, arterial insufficiency or by pressure due to prolonged contact with hard surfaces. AIM: This paper aims to verify whether non-pharmacological complementary therapy administration of platelet-rich plasma (PRP) accelerates tissue repair in chronic ulcers of the lower limbs. MATERIAL AND METHODS: A multiple study on patients with chronic ulcers of the lower limbs cases performed in outpatient services of a large hospital in Porto Alegre-RS. The cases were selected until theoretical exhaustion and similarities in the results. This study included ulcers of any etiology and excluded patients who had traumatic nerve damage, chronic obstructive pulmonary disease, celiac disease, Hansen's disease, Acquired Immune Deficiency Syndrome, acromegaly, sarcoidosis, cancer, systemic vasculitis; with the use of metronidazole, phenytoin, nitrofurantoin, amitriptyline, zidovudine (AZT), isoniazid, statins, amiodarone, cyclophosphamide, colchicines and vincristine; previous surgery for skin grafts in ulcer, presence of significant anemia, other causes of distal symmetric sensory and motor polyneuropathy such as hypothyroidism and a history of severe alcohol consumption. Data was collected by structured interview, observation and systematic review of the ulcer and photographic records. The application of PRP occurred on the first day after the assessment and subsequent applications in 7 days, 14 days, 22 days, 39 days, 54 days, 69 days, 89 days and 99 days. The analysis used was proposed by Glaser and Strauss (1967), which consists in developing a grounded theory through several procedures, gathering a volume of data related to the studied phenomenon. This study was approved by the ERCs of the institutions involved. RESULTS: Four ulcers met the criteria for selection of two male participants, one 49-year-old man, diabetic and hypertensive and a 79-year-old man with hypertension and arterial ischemia in the left lower limb and anticoagulated. It was possible to observe the complete closure of the wound, and a significant reduction of the other two treated with PRP. Only an ulcer showed no improvement related to its size, but there was a positive trend with regard to the presentation of tissue and the edges of it. Ulcers are of different etiologies, duration and size, thus experiencing different answers as to the speed and percentage of healing. We observed that age, ITB and use of anti platelet aggregator are factors that influence the outcome. CONCLUSION: The effect of PRP on the healing process of chronic wounds in the cases studied was effective in relation to therapies previously used. We hope this study may be a precursor to new methodological approaches for the validation of the technique of obtaining PRP, as well as for its popularization in health services.